1. Earhart, Ann MSN, RN, CRNI
  2. Kaminski, Darlene RN, CRNI

Article Content


Discuss the evolution of infusion therapy to the current process of vascular access and its impact on patient outcomes and satisfaction. Discuss the role of the Clinical Nurse Specialist in infusion therapy, increasing patient satisfaction, and increasing patient outcomes.



In today's healthcare environment, 90% of all hospitalized patients receive some type of intravenous therapy. This therapy can be nutrition, chemotherapy, hydration, electrolyte therapy, antibiotics, or a combination of therapies. Patient venous access varies from poor vein quality and poor circulation to good vein quality with excellent blood flow. Clinicians are currently infusing over 500 injectable drugs.



As healthcare providers, we must have a good understanding of vascular access. Due to drug composition, some conventional peripheral IVs do not last 72 hours. In fact, many conventional peripheral IVs only last 6 to 8 hours in a patient's vein before complications occur.



In a 600+ bed metropolitan hospital, a CNS lead a team of physicians, infection control nurses, and staff. The team assessed current practice and available resources and collected data on peripheral IV sites and central lines, including PICCs. Patient satisfaction scores were monitored.



Tools were evaluated and developed for evaluation of vascular access and are currently being implemented. SWAT type nurses that started IVs and PICC nurses were combined into one team to form a vascular access team. Nurses are being mentored at the bedside for IV starts for competencies. Policies are being revised to decrease pain and attempts for IV starts.



The key driver of this project was the CNS. Many facilities have infusion teams and vascular access teams, but in a team led by a CNS that promotes collecting data and using the evidence-based practice, outcomes were monitored. Patient satisfaction is increasing; nurse satisfaction is increasing.


Implications for Practice:

The role of the CNS in the development of this vascular access team was key. Assessment, evaluation, implementation, and reevaluation of any problem and process are the roles of the CNS.